摘要目的 探讨脑心死亡供体(DBCD)肝移植的可行性和安全性.方法 2011年9月至2014年4月,佛山市第一人民医院采用Maastricht标准或中国标准,共获取39例脑心死亡供肝.其中我院自行肝移植32例,5例供肝通过中国人体器官分配与共享系统(COTRS系统)分配到外院,2例弃用;对39例供体及佛山市第一人民医院完成的33例肝移植(1例供肝通过COTRS系统分配获得)的临床资料进行回顾性分析总结.结果 33例供体中,中国Ⅰ类(C-Ⅰ),脑死亡供体(DBD)11例,中国Ⅲ类(C-Ⅲ),DBCD 22例.供者中位年龄38岁,脑死亡原因:车祸伤22例,脑出血10例,脑干肿瘤1例.DBCD供肝的热缺血时间为3～21 min,平均为9.5 min;DBCD和DBD冷缺血时间为3.8～12.5 h,平均为5.2h.33例受者年龄38 ～64岁,中位年龄47.5岁.原发病包括原发性肝细胞癌11例,乙型肝炎后肝硬化8例,乙型肝炎急性肝功能衰竭6例,乙型肝炎慢加急性肝功能衰竭3例,丙型肝炎急性肝衰竭、乙肝合并丙肝肝硬化、自身免疫性肝炎、酒精性肝硬化、多囊肝合并多囊肾各1例.中位等待时间30 d,术后平均住院时间28.0 d,中位随访时间54周(13.5个月).术后32例受者存活,无原发性肝无功能发生,1例术后第9天死于多器官功能衰竭.结论 脑心死亡供体肝移植是安全和可行的.供体的评估和有效维护,缩短热、冷缺血时间,胆道并发症的防治,无激素免疫抑制方案以及核苷类似物的应用等是保证供体肝移植成功实施的关键因素.

abstractsObjective To study the safety and feasibility of liver transplantation using brain and cardiac death donors.Methods The organs from 39 brain and cardiac death donors were harvested at the First People's Hospital of Foshan between September 2011 and April 2014.Five livers were allocated to other liver transplant centers through the China Organ Transplant Response System (COTRS).Two livers were discarded because of major injury and severe hepatic steatosis, respectively.The data of the 39 remaining donors and 33 liver transplant recipients with liver transplantation carried out in our department (including one liver accepted through the COTRS from another transplant center) were retrospectively analyzed.Results Among the 33 donors, 11 were in the China category Ⅰ and 22 category Ⅲ using the classification of China donor after cardiac death.The median age was 38 years.The primary causes of death were brain injury after road accident (n =22), cerebral hemorrhage (n =10), and brain tumor (n =1).The average warm ischemic time of the China category Ⅲ donors was 9.5 min (range 3 ～21 min).The average cold ischemic time of all the donors was 5.2 hours (ranged 3.8 ～ 12.5 h).The median age of the liver transplant recipients was 47.5 years (range 38 to 64 years).The primary disease of the liver transplant recipients was liver cirrhosis due to hepatitis B virus (HBV) infection (n =8), liver failure due to hepatitis C virus (HCV) infection (n =1), liver cirrhosis due to combined HBV and HCV infection (n =1), autoimmune hepatitis (n =1), alcoholic liver cirrhosis (n =1), acute liver function failure due to HBV infection (n =6), acute on chronic liver failure due to HBV infection (n =3), polycystic liver and kidney (n =1), and hepatocellular carcinoma (n =11).The median wait for liver transplantation was 30 days.The median hospitalization after liver transplantation was 28.0 days.At a median follow up of 54 weeks (or 13.5 months), 32 liver recipients were alive and well.One liver recipient died on the ninth day after operation because of multi-organ failure.There was no primary graft non-functioning.Conclusions Liver transplantation using brain and cardiac death donors was safe and feasible.Important measures for success include optimal management of donors, reduction of warm and cold ischemic time, prevention of biliary complications, use of immunosuppression with non steroidals and nucleoside/nucleotide analogs.